Yes

Yes. There is every tendency to improve the outcome.

In patients with acute, low-risk chest pain (meaning negative troponin and nonischemic ECG; majority of US chest pain population) there is no evidence that CT angiography improves outcomes compared to the standard pathway of functional stress testing but it does lead to a significant increase in catheterization and revascularization procedures.  The revascularization rate is twice a high and the absolute number of patients needed to test with CCTA to lead to one excess revascularization is only 30-40. This is not beneficial and could be harmful. Furthermore, radiation exposure from CCTA is an unnecessary hazard. While the radiation dose is less than nuclear stress testing, stress echocardiography, which is arguably the best modality, has none. Finally, there is NO evidence that performing ANY diagnostic test in this low-risk population is beneficial and several, large comparative studies suggest it is NOT.  So we should think hard about performing ANY test, since there is no strong evidence to support it. AND, if you insist on performing a test, it should be safe and associated with the least risk of unnecessary downstream invasive procedures, which is stress echo.

In patients with intermediate-risk chest pain (

Yes... of course only  in case that clinical, non invasive diagnostic examinations or laboratory results make a  chest ct  necessary to exclude  pulmoray embolism, coronary desease, aortic dissection, otherwise we should have a ct scanner in every houshold.

Patient admitted with acute MI (as diagnosed by ECG changes and/or troponin rise) should have a coronary angiogram and primary PCI as early as possible to reduce door to balloon time. Patients with unstable angina should also have a coronary angiogram during this admission. Other patients with acute chest pain but without a clinical picture of acute coronary syndrome may benefit from CT angiography only if the history indicates that the pain is likely to be from ischaemic heart disease

I am an old and for a  long time retired acute cardiologist with more than 15.000 ACS patients treated in CCU plus thousands and thousands of suspected ambulatory patients. My answer is very short: would you always use AA canons or cruised missiles against mosquitos?  Good medical knowledge plus rich clinical practice should always select diagnostic procedures minimally harmful and optimally useful. 

Dear Dr. Nedok.

unfortunately your country and many of your fellow countrymen had been cowardly hit by missiles, so your experience im missiles must also be an important one.

I don't know how good the public health system (relatives of mine worked for more than a year in Belgrad...)  in Serbia is and how big the availability of CT Scanners. In richer countries frequently there is certainly an overmedication, but if you perform a CT to exclude a LE it is not a "mistake" to exclude a dissection and a coronary problem in the same time.

Numbers don't mean always quality

Amen

I think it is a very important investigation where other test are noncontributary. It has got the advantage of diagnosing aortic dissection, pulmonary embolism, mediastinal and pericardial pathology as a cause of chest pain. It is much safer investigation than invasive procedure. 

Dead Dr Antonucci, I sad I am an old cardiologist, it means maybe too conservative, and I believe that our Art of Medicine is in the first line the result of observational experience, and of good statistical analysis, I also believe that the first law in our practice of medicine is still: primum nil nocere. Naturally, I agree that the quantity not always transforms in quality, but that it depends from how good the doctors in question are. So, I think that a really good doctor should be able to use minimum of diagnostic procedures to confirm his clinical diagnosis or to exclude his suspicions, but in contrary, who do not hesitate to perform any potentially harmful diagnostic method if it is absolutely indicated..This was and I believe still is the sane Philosophy of Medical Practice.

At the end, thank You for remembrance on Days of missile terror,  of about 2.500 killed innocent people and children, and of incredible devastations of my Country in the mid of Europe at the end of XX Century by our ex allies and without permission of UN Security Council. As a WW II veteran I never believed it could happen again.

Dear Dr Nedok,  I agree with your opinion. With good clinical knowledge, majority of patients will probably not required CT angiography but few patient will definitely benefit where Clinical and routine investigation are noncontributary. 

yes!

yes in patients with severe pain, because you can exclude triple etiology: coronary, aortic or pulmonary embolic chest pain

It certainly has a role to play. The following article describes the various factors involved: http://circ.ahajournals.org/content/133/20/1963